Provider Demographics
NPI:1992859276
Name:MOCKRIN, DEBORAH-RUTH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH-RUTH
Middle Name:
Last Name:MOCKRIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 NAGOG HILL RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3227
Mailing Address - Country:US
Mailing Address - Phone:978-635-0225
Mailing Address - Fax:
Practice Address - Street 1:219 NAGOG HILL RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3227
Practice Address - Country:US
Practice Address - Phone:978-635-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03676Medicare PIN